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Arribas C, Decembrino N, Raffaeli G, Amodeo I, González-Caballero JL, Riaza M, Ortiz-Movilla R, Massenzi L, Gizzi C, Araimo G, Cattarelli D, Aversa S, Martinelli S, Frezza S, Orfeo L, Mosca F, Cavallaro G, Garrido F. Ototoxic and nephrotoxic drugs in neonatal intensive care units: results of a Spanish and Italian survey. Eur J Pediatr 2024:10.1007/s00431-024-05467-w. [PMID: 38492032 DOI: 10.1007/s00431-024-05467-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 03/18/2024]
Abstract
Neonates face heightened susceptibility to drug toxicity, often exposed to off-label medications with dosages extrapolated from adult or pediatric studies. Premature infants in Neonatal Intensive Care Units (NICUs) are particularly at risk due to underdeveloped pharmacokinetics and exposure to multiple drugs. The study aimed to survey commonly used medications with a higher risk of ototoxicity and nephrotoxicity in Spanish and Italian neonatal units. A prospective cross-sectional study was conducted in Italian and Spanish neonatal units using a web-based survey with 43 questions. A modified Delphi method involved experts refining the survey through online consensus. Ethical approval was obtained, and responses were collected from January to July 2023. The survey covered various aspects, including drug-related ototoxic and nephrotoxic management, hearing screening, and therapeutic drug monitoring. Responses from 131 participants (35.9% from Spain and 64.1% from Italy) revealed awareness of drug toxicity risks. Varied practices were observed in hearing screening protocols, and a high prevalence of ototoxic and nephrotoxic drug use, including aminoglycosides (100%), vancomycin (70.2%), loop diuretics (63.4%), and ibuprofen (62.6%). Discrepancies existed in guideline availability and adherence, with differences between Italy and Spain in therapeutic drug monitoring practices. CONCLUSIONS The study underscores the need for clinical guidelines and uniform practices in managing ototoxic and nephrotoxic drugs in neonatal units. Awareness is high, but inconsistencies in practices indicate a necessity for standardization, including the implementation of therapeutic drug monitoring and the involvement of clinical pharmacologists. Addressing these issues is crucial for optimizing neonatal care in Southern Europe. WHAT IS KNOWN • Neonates in intensive care face a high risk of nephrotoxicity and ototoxicity from drugs like aminoglycosides, vancomycin, loop diuretics, and ibuprofen. • Therapeutic drug monitoring is key for managing these risks, optimizing dosing for efficacy and minimizing side effects. WHAT IS NEW • NICUs in Spain and Italy show high drug toxicity awareness but differ in ototoxic/nephrotoxic drug management. • Urgent need for standard guidelines and practices to address nephrotoxic risks from aminoglycosides, vancomycin, loop diuretics, and ibuprofen.
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Affiliation(s)
- Cristina Arribas
- Neonatal Intensive Care Unit, Clínica Universidad de Navarra, 28027, Madrid, Spain
| | - Nunzia Decembrino
- Neonatal Intensive Care Unit, AOU Policlinico G. Rodolico San Marco, 95123, Catania, Italy
| | - Genny Raffaeli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy.
| | - Ilaria Amodeo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | | | - Mónica Riaza
- Department of Pediatrics, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Roberto Ortiz-Movilla
- Neonatal Intensive Care Unit, Hospital Universitario Puerta de Hierro-Majadahonda, 28222, Madrid, Spain
| | - Luca Massenzi
- Neonatal Intensive Care Unit, Ospedale Regionale Di Bolzano, 39100, Bolzano, Italy
| | - Camilla Gizzi
- Division of Pediatrics and Neonatology, Sandro Pertini Hospital, 00157, Rome, Italy
| | - Gabriella Araimo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Donatella Cattarelli
- Division of Pediatrics and Neonatology, ASST del Garda, 25015, Desenzano del Garda (BS), Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, 25123, Brescia, Italy
| | - Stefano Martinelli
- Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162, Milan, Italy
| | - Simonetta Frezza
- Division of Neonatology, Area of Child Health, Department of Woman, Child Health and Public Health, Fondazione IRCCS Policlinico Universitario Agostino Gemelli, 00168, Rome, Italy
| | - Luigi Orfeo
- Neonatal Intensive Care Unit, Isola Tiberina Hospital Gemelli Isola, 00186, Rome, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, 20122, Milan, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Felipe Garrido
- Neonatal Intensive Care Unit, Clínica Universidad de Navarra, 28027, Madrid, Spain
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Di Pietro M, Decembrino N, Afflitto MG, Malerba E, Avitabile T, Franco LM, Longo A, Betta P. Risk factors in the development of retinopathy of prematurity: A 10-year retrospective study. Early Hum Dev 2023; 185:105844. [PMID: 37672895 DOI: 10.1016/j.earlhumdev.2023.105844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To evaluate Retinopathy of Prematurity (ROP) rate and risk factors in a large cohort of preterm newborns. METHODS Single center retrospective study. All preterm inborn hospitalized at the Neonatal Intensive Care Unit of the Policlinico of Catania from January 1, 2009 till December 31, 2018, were included. ROP stage and location, treatments required, maternal and infant risk factors were evaluated. RESULTS Medical records of 898 preterms were retrospectively examined (mean gestational age 32.9 ± 2.3 weeks). Of them 149 (16.6 %) developed bilateral ROP (92 stage 1, 44 stage 2 and 13 stage 3); 66 (7.3 %) received bilateral laser treatment. Six eyes of three patients affected by zone I ROP 1, with plus persistence 15 days after an optimal laser treatment, also received intravitreal ranibizumab injection. Risk factors for ROP development were gestational age (GA) (p < 0.001), birthweight (p < 0.001), assisted ventilation duration (p < 0.001), multiple birth (p = 0.003), erythropoietin (EPO) administration (p = 0.005) and persistence of tunica vasculosa lentis. The decision-tree analysis showed gestational age as the most significant predictive factor (P < 0.001); secondary predictive factors were EPO administration (p = 0.001) in newborns 29-31 weeks GA and birthweight lower than 2090 g (p < 0.001) in 32-34 weeks GA; in this latter group patent ductus arteriosus (PDA) was a tertiary predictive factor (p = 0.043). CONCLUSIONS In our study ROP incidence was 16,6 %; 7.3 % of the patients required laser treatment. Besides well-known factors, such as GA and birthweight, other factors like duration of assisted ventilation, EPO, multiple births, PDA, tunica vasculosa lentis persistence should be considered to tailor ophthalmic evaluation and follow-up.
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Affiliation(s)
- Massimo Di Pietro
- Department of General Surgery and Surgical Specialties, AOU Policlinico-San Marco, University of Catania, via S. Sofia 78, 95100 Catania, Italy.
| | - Nunzia Decembrino
- Integrated Activity Department for the Protection of Mother and Child Health, Neonatal Intensive Care Unit, AOU Policlinico-San Marco, University of Catania, via S. Sofia 78, 95100 Catania, Italy.
| | - Miriam Gallo Afflitto
- Multizonal Ophtalmology Unit, Hospital of Trento and Rovereto, corso Verona, 4, 38068 Rovereto, Italy.
| | - Emilio Malerba
- Department of General Surgery and Surgical Specialties, AOU Policlinico-San Marco, University of Catania, via S. Sofia 78, 95100 Catania, Italy
| | - Teresio Avitabile
- Department of General Surgery and Surgical Specialties, AOU Policlinico-San Marco, University of Catania, via S. Sofia 78, 95100 Catania, Italy.
| | - Livio Marco Franco
- Ophtalmology Unit, Great Metropolitan Hospital of Reggio Calabria, via G. Melacrino 21, 891244 Reggio Calabria, Italy
| | - Antonio Longo
- Department of General Surgery and Surgical Specialties, AOU Policlinico-San Marco, University of Catania, via S. Sofia 78, 95100 Catania, Italy.
| | - Pasqua Betta
- Integrated Activity Department for the Protection of Mother and Child Health, Neonatal Intensive Care Unit, AOU Policlinico-San Marco, University of Catania, via S. Sofia 78, 95100 Catania, Italy
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Decembrino N, Gitto E, Fedeli T, Spagnuolo F, Orfeo L, Moretti C, Cogo P, Pozzi N. Where PICU Beds Are Lacking, the Model of "Extended NICU" May Help to Treat Infants and Small Toddlers Who Are Critically Ill, Even During the COVID-19 Pandemic. Chest 2022; 162:e289-e290. [PMID: 36344147 PMCID: PMC9634040 DOI: 10.1016/j.chest.2022.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Nunzia Decembrino
- Neonatal Intensive Care Unit, University Hospital Policlinico "G. Rodolico San Marco", Catania, Italy.
| | - Eloisa Gitto
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Neonatal and Paediatric Intensive Care Unit, University of Messina, Messina, Italy
| | - Tiziana Fedeli
- Neonatal Intensive Care Unit, Fondazione Monza e Brianza per il Bambino e la sua Mamma and Azienda Socio-Sanitaria-Territoriale Monza, Monza, Italy
| | - Ferdinando Spagnuolo
- Department of Neonatology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Orfeo
- Neonatal Intensive Care Unit, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - Corrado Moretti
- Emeritus Consultant in Paediatrics, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Paola Cogo
- Department of Medicine (DAME), Division of Pediatrics, S. Maria della Misericordia University Hospital, University of Udine, Udine, Italy
| | - Nicola Pozzi
- Department of Maternal and Child Health, Neonatal Intensive Care Unit, San Pio Hospital, Benevento, Italy
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Simeoli R, Cairoli S, Decembrino N, Campi F, Dionisi Vici C, Corona A, Goffredo BM. Use of Antibiotics in Preterm Newborns. Antibiotics (Basel) 2022; 11:antibiotics11091142. [PMID: 36139921 PMCID: PMC9495226 DOI: 10.3390/antibiotics11091142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022] Open
Abstract
Due to complex maturational and physiological changes that characterize neonates and affect their response to pharmacological treatments, neonatal pharmacology is different from children and adults and deserves particular attention. Although preterms are usually considered part of the neonatal population, they have physiological and pharmacological hallmarks different from full-terms and, therefore, need specific considerations. Antibiotics are widely used among preterms. In fact, during their stay in neonatal intensive care units (NICUs), invasive procedures, including central catheters for parental nutrition and ventilators for respiratory support, are often sources of microbes and require antimicrobial treatments. Unfortunately, the majority of drugs administered to neonates are off-label due to the lack of clinical studies conducted on this special population. In fact, physiological and ethical concerns represent a huge limit in performing pharmacokinetic (PK) studies on these subjects, since they limit the number and volume of blood sampling. Therapeutic drug monitoring (TDM) is a useful tool that allows dose adjustments aiming to fit plasma concentrations within the therapeutic range and to reach specific drug target attainment. In this review of the last ten years’ literature, we performed Pubmed research aiming to summarize the PK aspects for the most used antibiotics in preterms.
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Affiliation(s)
- Raffaele Simeoli
- Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Sara Cairoli
- Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Nunzia Decembrino
- Neonatal Intensive Care Unit, University Hospital “Policlinico-San Marco” Catania, Integrated Department for Maternal and Child’s Health Protection, 95100 Catania, Italy
| | - Francesca Campi
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Carlo Dionisi Vici
- Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Alberto Corona
- ICU and Accident & Emergency Department, ASST Valcamonica, 25043 Breno, Italy
| | - Bianca Maria Goffredo
- Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
- Correspondence: ; Tel.: +39-0668592174; Fax: + 39-0668593009
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D’Amico F, Decembrino N, Muratore E, Turroni S, Muggeo P, Mura R, Perruccio K, Vitale V, Zecca M, Prete A, Venturelli F, Leardini D, Brigidi P, Masetti R, Cesaro S, Zama D. Oral Lactoferrin Supplementation during Induction Chemotherapy Promotes Gut Microbiome Eubiosis in Pediatric Patients with Hematologic Malignancies. Pharmaceutics 2022; 14:pharmaceutics14081705. [PMID: 36015331 PMCID: PMC9416448 DOI: 10.3390/pharmaceutics14081705] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 12/19/2022] Open
Abstract
Induction chemotherapy is the first-line treatment for pediatric patients with hematologic malignancies. However, several complications may arise, mainly infections and febrile neutropenia, with a strong impact on patient morbidity and mortality. Such complications have been shown to be closely related to alterations of the gut microbiome (GM), making the design of strategies to foster its eubiosis of utmost clinical importance. Here, we evaluated the impact of oral supplementation of lactoferrin (LF), a glycoprotein endowed with anti-inflammatory, immunomodulatory and antimicrobial activities, on GM dynamics in pediatric oncohematologic patients during induction chemotherapy. Specifically, we conducted a double blind, placebo-controlled trial in which GM was profiled through 16S rRNA gene sequencing before and after two weeks of oral supplementation with LF or placebo. LF was safely administered with no adverse effects and promoted GM homeostasis by favoring the maintenance of diversity and preventing the bloom of pathobionts (e.g., Enterococcus). LF could, therefore, be a promising adjunct to current therapeutic strategies in these fragile individuals to reduce the risk of GM-related complications.
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Affiliation(s)
- Federica D’Amico
- Microbiomics Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Nunzia Decembrino
- Neonatal Intensive Care Unit-AOU Policlinico “Rodolico-San Marco”, University of Catania, 95131 Catania, Italy
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Edoardo Muratore
- Pediatric Hematology and Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Correspondence: (E.M.); (S.T.)
| | - Silvia Turroni
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
- Correspondence: (E.M.); (S.T.)
| | - Paola Muggeo
- Pediatric Hematology and Oncology Department, University of Bari, 70121 Bari, Italy
| | - Rosamaria Mura
- Pediatric Hematology and Oncology Department, “A Cao” Microcitemic Pediatric Hospital, “Botzu” Medical Center, 09100 Cagliari, Italy
| | - Katia Perruccio
- Pediatric Hematology and Oncology Department, “Santa Maria della Misericordia” Hospital, 06132 Perugia, Italy
| | - Virginia Vitale
- Pediatric Hematology and Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, 37126 Verona, Italy
| | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Arcangelo Prete
- Pediatric Hematology and Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Francesco Venturelli
- Pediatric Hematology and Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40138 Bologna, Italy
| | - Davide Leardini
- Pediatric Hematology and Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Patrizia Brigidi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Riccardo Masetti
- Pediatric Hematology and Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Simone Cesaro
- Pediatric Hematology and Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, 37126 Verona, Italy
| | - Daniele Zama
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Muggeo P, Zama D, Decembrino N, Onofrillo D, Frenos S, Colombini A, Perruccio K, Calore E, Giurici N, Ficara M, La Spina M, Mura R, De Santis R, Santoro N, Cesaro S. Ecthyma Gangrenosum in Children With Cancer: Diagnosis at a Glance: A Retrospective Study From the Infection Working Group of Italian Pediatric Hematology Oncology Association. Pediatr Infect Dis J 2022; 41:238-242. [PMID: 34694251 DOI: 10.1097/inf.0000000000003377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To depict ecthyma gangrenosum (EG) clinical presentation and evolution in a large multicenter pediatric retrospective collection of children with malignancies or bone marrow failure syndromes, to facilitate early diagnosis. METHODS EG episodes diagnosed in the period 2009-2019 were identified by a retrospective review of clinical charts at centers belonging to the Italian Pediatric Hematology Oncology Association. RESULTS Thirty-eight cases of EG occurring in children (male/female 16/22; median age 5.2 years) with hematologic malignancy (29), allogeneic stem cell transplantation (2) or relapsed/refractory solid tumor (3) were collected. The involved sites were: perineal region (19), limbs (10), trunk (6), head and the iliac crest (3). Bacteremia was present in 22 patients. Overall, the germs isolated were Pseudomonas aeruginosa (30), Stenotrophomonas maltophilia (3) and Escherichia coli (1); 31% of them were multidrug-resistant. All patients received antibacterial treatment, while surgery was performed in 24 patients (63.1%). Predisposing underlying conditions for EG were severe neutropenia (97.3%), corticosteroid treatment (71%) and iatrogenic diabetes (23.7%). All patients recovered, but EG recurred in 5 patients. Nine patients (24%) showed sequelae (deep scars, with muscle atrophy in 2). Four patients (10.5%) died, 1 due to relapse of EG with Carbapenem-resistant Enterobacteriaceae co-infection and 3 due to the progression of the underlying disease. CONCLUSIONS EG requires early recognition and a proper and timely treatment to obtain the recovery and to avoid larger necrotic lesions, eventually evolving in scarring sequelae.
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Affiliation(s)
- Paola Muggeo
- From the Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari
| | - Daniele Zama
- Paediatric Oncology and Haematology Unit "Lalla Seràgnoli", Department of Paediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Bologna
| | - Nunzia Decembrino
- Pediatric Hematology Oncology, IRCCS Policlinico San Matteo, University of Pavia
- Terapia Intensiva Neonatale, AOU Policlinico "G. Rodolico-San Marco", Catania
| | - Daniela Onofrillo
- UOS di Oncoematologia Pediatrica, Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Ospedale Spirito Santo, Pescara
| | | | - Antonella Colombini
- Pediatric Hemato-Oncology, Fondazione MBBM, Milano Bicocca University, San Gerardo Hospital, Monza
| | - Katia Perruccio
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria, Ospedale Santa Maria della Misericordia, Perugia
| | - Elisabetta Calore
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova
| | - Nagua Giurici
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste
| | - Monica Ficara
- Scuola di Specializzazione in Pediatria, Università degli Studi di Modena e Reggio Emilia; SC di Oncoematologia Pediatrica, AOU Policlinico di Modena
| | - Milena La Spina
- Centro di Riferimento Regionale di Ematologia ed Oncologia Pediatrica, AOU Policlinico "G. Rodolico-San Marco", Catania
| | - Rosamaria Mura
- Oncoematologia Pediatrica e Patologia della Coagulazione, Ospedale Pediatrico Microcitemico "Antonio Cao", AO Brotzu, Cagliari
| | - Raffaella De Santis
- UOC Oncoematoogia Pediatrica, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - Nicola Santoro
- From the Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Policlinico "G.B: Rossi", Verona, Italy
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7
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Del Principe MI, Dragonetti G, Conti A, Verga L, Ballanti S, Fanci R, Candoni A, Marchesi F, Cattaneo C, Lessi F, Fracchiolla N, Spolzino A, Prezioso L, Delia M, Potenza L, Decembrino N, Castagnola C, Nadali G, Picardi M, Zama D, Orciulo E, Veggia B, Garzia M, Dargenio M, Melillo L, Manetta S, Russo D, Mancini V, Piedimonte M, Tisi MC, Toschi N, Busca A, Pagano L. Invasive aspergillosis in relapsed/refractory acute myeloid leukaemia patients: Results from SEIFEM 2016-B survey. Mycoses 2021; 65:171-177. [PMID: 34695256 DOI: 10.1111/myc.13384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In patients with relapsed/refractory acute myeloid leukaemia (R/R AML) who received salvage chemotherapy, limited and not updated studies explored the incidence of invasive aspergillosis (IA) and the role of antifungal prophylaxis (AP). The aims of this multicentre retrospective 'SEIFEM 2016-B' study were as follows: (1) to evaluate the current rate and the outcome of proven/probable IA and (2) to assess the efficacy of AP, in a large 'real life' series of patient with R/R AML submitted to salvage chemotherapy. RESULTS Of 2250 R/R AML patients, a total of 74 cases of IA (5.1%) were recorded as follows: 10 (0.7%) proven and 64 (4.3%) probable. Information about AP were available in 73/74 (99%) patients. Fifty-eight (79%) breakthrough infections occurred, mainly during AP with posaconazole [25 (43%)]. The patients who received AP during salvage chemotherapy showed a benefit from antifungal therapy (AT) than patients who did not received AP [43 (86%) vs 7 (14%); p < .033]. In a multivariate analysis, AP and absence of severe mucositis had a significant favourable effect on overall response rate. CONCLUSION Our data demonstrated that the incidence of IA during the salvage chemotherapy is similar to the past. Nevertheless, the attributable mortality rate (AMR) appears to be lower than that previously reported in R/R AML. Further prospective studies should be performed to confirm our preliminary observation and understand and the why a decreased AMR is reported in this setting of high-risk patients.
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Affiliation(s)
- Maria Ilaria Del Principe
- Cattedra di Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma 'Tor Vergata', Roma, Italy
| | - Giulia Dragonetti
- Istituto di Ematologia, Fondazione Policlinico Universitario A. Gemelli-IRCSS-Università Cattolica del Sacro Cuore, Roma, Italy
| | - Allegra Conti
- Sezione di Fisica Medica, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma 'Tor Vergata', Roma, Italy
| | - Luisa Verga
- Clinica Ematologica, Ospedale San Gerardo, ASST Monza, Università Milano Bicocca, Milano, Italy
| | - Stelvio Ballanti
- Dipartimento di Ematologia, Ospedale Santa Maria della Misericordia, Università di Perugia, Perugia, Italy
| | - Rosa Fanci
- Unità di Ematologia, Ospedale Careggi ed Università di Firenze, Firenze, Italy
| | - Anna Candoni
- Clinica di Ematologia e Unità di terapie Cellulari 'Carlo Melzi'-Azienda Sanitaria-Universitaria, Integrata, Udine, Italy
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - Chiara Cattaneo
- Divisione di Ematologia, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Federica Lessi
- Divisione di Ematologia e Immunologia Clinica, Università di Padova, Padova, Italy
| | - Nicola Fracchiolla
- UOC Ematologia, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
| | - Angelica Spolzino
- Hematology and BMT Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Lucia Prezioso
- Hematology and BMT Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Mario Delia
- Hematology and Stem Cell Transplantation Unit-Azienda, Ospedaliero-Universitaria Consorziale-Policlinico di Bari, Bari, Italy
| | - Leonardo Potenza
- UOC Ematologia, Dipartimento di Scienze Mediche e Chirurgiche Materno infantili e dell'Adulto, Università di Modena e Reggio Emilia, Modena, Italy
| | - Nunzia Decembrino
- UOC Oncoematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlo Castagnola
- Divisione di Ematologia, Fondazione ICRRS Policlinico San Matteo, Pavia, Italy
| | - Gianpaolo Nadali
- Unità Operativa Complessa di Ematologia, Azienda Ospedaliera Universitaria Integrata diVerona, Verona, Italy
| | - Marco Picardi
- Dipartimento di Medicina Clinica e Chirurgia, Unità di Ematologia, Università Federico II, Napoli, Italy
| | - Daniele Zama
- Pediatric Oncology and Hematology 'Lalla Seràgnoli', Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Enrico Orciulo
- Dipartimento di Oncologia, Trapianti e Tecnologie Avanzate, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Barbara Veggia
- Dipartimento di Ematologia, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Mariagrazia Garzia
- UOC Ematologia-Trapianto cellule staminali, Azienda Ospedaliera S.Camillo-Forlanini, Roma, Italy
| | - Michelina Dargenio
- Unità di Ematologia e Trapianto di Cellule Staminali, Ospedale Vito Fazzi, Lecce, Italy
| | - Lorella Melillo
- Divisione di Ematologia, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Sara Manetta
- Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Torino, Italy
| | - Domenico Russo
- Cattedra di Ematologia USD Trapianti di Midollo Osseo per Adulti Spedali Civili di Brescia, Università di Brescia, ASST SpedaliCivili di Brescia, Brescia, Italy
| | - Valentina Mancini
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, Milano, Italy
| | - Monica Piedimonte
- Dipartimento di Medicina Clinica e Molecolare, Ematologia Ospedale Universitario Sant'Andrea, Università la Sapienza di Roma, Roma, Italy
| | - Maria Chiara Tisi
- Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy.,Divisione di Ematologia, Ospedale San Bortolo, Vicenza, Italy
| | - Nicola Toschi
- Sezione di Fisica Medica, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma 'Tor Vergata', Roma, Italy.,Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, Massachusetts, USA
| | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Torino, Italy
| | - Livio Pagano
- Istituto di Ematologia, Fondazione Policlinico Universitario A. Gemelli-IRCSS-Università Cattolica del Sacro Cuore, Roma, Italy
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8
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Decembrino N, Perruccio K, Zecca M, Colombini A, Calore E, Muggeo P, Soncini E, Comelli A, Molinaro M, Goffredo BM, De Gregori S, Giardini I, Scudeller L, Cesaro S. A Case Series and Literature Review of Isavuconazole Use in Pediatric Patients with Hemato-oncologic Diseases and Hematopoietic Stem Cell Transplantation. Antimicrob Agents Chemother 2020; 64:e01783-19. [PMID: 31871077 PMCID: PMC7038308 DOI: 10.1128/aac.01783-19] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 12/10/2019] [Indexed: 01/12/2023] Open
Abstract
We analyzed the use of isavuconazole (ISA) as treatment or prophylaxis for invasive fungal disease (IFD) in children with hemato-oncologic diseases. A multicentric retrospective analysis was performed among centers belonging to the Italian Association for Pediatric Hematology and Oncology (AIEOP). Pharmacokinetic (PK) monitoring was applied by a high-performance liquid chromatography-tandem mass spectrometry (HLPC-MS/MS) assay. Twenty-nine patients were studied: 10 during chemotherapy and 19 after allogeneic hematopoietic stem cell transplantation (HSCT). The patients consisted of 20 males and 9 females with a median age of 14.5 years (age range, 3 to 18 years) and a median body weight of 47 kg (body weight range, 15 to 80 kg). ISA was used as prophylaxis in 5 patients and as treatment in 24 cases (20 after therapeutic failure, 4 as first-line therapy). According to European Organization for Research and Treatment of Cancer (EORTC) criteria, we registered 5 patients with proven IFD, 9 patients with probable IFD, and 10 patients with possible IFD. Patients with a body weight of <30 kg received half the ISA dose; the others received ISA on the adult schedule (a 200-mg loading dose every 8 h on days 1 and 2 and a 200-mg/day maintenance dose); for all but 10 patients, the route of administration switched from the intravenous route to the oral route during treatment. ISA was administered for a median of 75.5 days (range, 6 to 523 days). The overall response rate was 70.8%; 12 patients with IFD achieved complete remission, 5 achieved partial remission, 5 achieved progression, and 3 achieved stable IFD. No breakthrough infections were registered. PK monitoring of 17 patients revealed a median ISA steady-state trough concentration of 4.91 mg/liter (range, 2.15 to 8.54 mg/liter) and a concentration/dose (in kilograms) ratio of 1.13 (range, 0.47 to 3.42). Determination of the 12-h PK profile was performed in 6 cases. The median area under the concentration-time curve from 0 to 12 h was 153.16 mg·h/liter (range, 86.31 to 169.45 mg·h/liter). Common Terminology Criteria for Adverse Events grade 1 to 3 toxicity (increased transaminase and/or creatinine levels) was observed in 6 patients, with no drug-drug interactions being seen in patients receiving immunosuppressants. Isavuconazole may be useful and safe in children with hemato-oncologic diseases, even in the HSCT setting. Prospective studies are warranted.
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Affiliation(s)
- N Decembrino
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - K Perruccio
- Division of Pediatric Hematology, University Hospital of Perugia, Perugia, Italy
| | - M Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Colombini
- Pediatric Hematology/Oncology, Fondazione Monza e Brianza per il Bambino e la Mamma, Monza, Italy
| | - E Calore
- Clinic of Pediatric Hematology/Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - P Muggeo
- Department of Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari, Italy
| | - E Soncini
- Pediatric Hematology/Oncology, Spedali Civili, Brescia, Italy
| | - A Comelli
- Department of Infectious and Tropical Diseases, Spedali Civili, Brescia, Italy
| | - M Molinaro
- Clinical and Experimental Pharmacokinetics Lab, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - B M Goffredo
- Metabolic Pathology Lab, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - S De Gregori
- Clinical and Experimental Pharmacokinetics Lab, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - I Giardini
- Clinical and Experimental Pharmacokinetics Lab, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - L Scudeller
- Clinical Epidemiology and Biometric Unit, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Cesaro
- Pediatric Hematology/Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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9
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Marchesi F, Cattaneo C, Criscuolo M, Delia M, Dargenio M, Del Principe MI, Spadea A, Fracchiolla NS, Melillo L, Perruccio K, Alati C, Russo D, Garzia M, Brociner M, Cefalo M, Armiento D, Cesaro S, Decembrino N, Mengarelli A, Tumbarello M, Busca A, Pagano L. A bronchoalveolar lavage-driven antimicrobial treatment improves survival in hematologic malignancy patients with detected lung infiltrates: A prospective multicenter study of the SEIFEM group. Am J Hematol 2019; 94:1104-1112. [PMID: 31321791 DOI: 10.1002/ajh.25585] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/08/2019] [Accepted: 07/13/2019] [Indexed: 12/15/2022]
Abstract
Bronchoalveolar lavage (BAL) is recommended for diagnosing lung infiltrates (LI) in patients with hematologic malignancy (HM). Prospective data on the impact of BAL on survival are still lacking. We conducted a prospective observational study on patients who performed BAL for LI among 3055 HM patients hospitalized from January to September 2018. The BAL was performed in 145 out of 434 patients who developed LI, at a median time of four days from LI detection. The median age was 60 (1-83). Most patients had an acute myeloid leukemia/myelodisplastic syndrome (81), followed by lymphoma (41), acute lymphoblastic leukemia (27), and other types of HM (36). A putative causal agent was detected in 111 cases (76%), and in 89 cases (61%) the BAL results provided guidance to antimicrobial treatment. We observed a significantly improved outcome of LI at day +30 in patients who could receive a BAL-driven antimicrobial treatment (improvement/resolution rate: 71% vs 55%; P = .04). Moreover, we observed a significantly improved outcome in 120-day overall survival (120d-OS) (78% vs 59%; P = .009) and 120-day attributable mortality (120d-AM) (11% vs 30%; P = 0.003) for patients who could receive a BAL-driven treatment. The multivariate analysis showed that BAL-driven antimicrobial treatment was significantly associated with better 120d-OS and lower 120d-AM. We did not observe any severe adverse events. In conclusion BAL allows detection of a putative agent of LI in about 75% of cases, it is feasible and well tolerated in most cases, demonstrating that a BAL-driven antimicrobial treatment allows improvement of clinical outcome and survival.
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Affiliation(s)
- Francesco Marchesi
- Hematology and Stem Cell Transplant UnitIRCCS Regina Elena National Cancer Institute Rome Italy
| | - Chiara Cattaneo
- Hematology DivisionASST‐Spedali Civili di Brescia Brescia Italy
| | - Marianna Criscuolo
- Fondazione Policlinico Universitario Agostino Gemelli – IRCCS Rome Italy
| | - Mario Delia
- Hematology and Bone Marrow Transplantation Unit, Department of Emergency and Organ TransplantationUniversity of Bari Bari Italy
| | - Michelina Dargenio
- Hematology and Stem Cell Transplantation Unit'Vito Fazzi' Hospital Lecce Italy
| | | | - Antonio Spadea
- Hematology and Stem Cell Transplant UnitIRCCS Regina Elena National Cancer Institute Rome Italy
| | | | - Lorella Melillo
- UO of Hematology, Foundation IRCSS Casa Sollievo della Sofferenza Hospital San Giovanni Rotondo Italy
| | - Katia Perruccio
- Pediatric Hematology OncologyUniversity Hospital Santa Maria della Misericordia Perugia Italy
| | - Caterina Alati
- Hematology UnitBianchi‐Melacrino‐Morelli Hospital Reggio Calabria Italy
| | - Domenico Russo
- Bone Marrow Transplant UnitUniversity of Brescia and ASST‐Spedali Civili Brescia Italy
| | | | - Marco Brociner
- Division of HematologyFoundation IRCCS Policlinico San Matteo, University of Pavia Pavia Italy
| | | | - Daniele Armiento
- Hematology and Stem Cell Transplantation UnitUniversity Campus Bio‐Medico Rome Italy
| | - Simone Cesaro
- Pediatric Hematology OncologyAzienda Ospedaliera Universitaria Integrata Verona Italy
| | - Nunzia Decembrino
- Pediatric Hematology OncologyIRCCS Policlinico San Matteo, University of Pavia Pavia Italy
| | - Andrea Mengarelli
- Hematology and Stem Cell Transplant UnitIRCCS Regina Elena National Cancer Institute Rome Italy
| | - Mario Tumbarello
- Fondazione Policlinico Universitario Agostino Gemelli – IRCCS Rome Italy
- Istituto di Malattie Infettive, Università Cattolica del Sacro Cuore Rome Italy
| | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' della Salute e Della Scienza Turin Italy
| | - Livio Pagano
- Fondazione Policlinico Universitario Agostino Gemelli – IRCCS Rome Italy
- Istituto di Ematologia, Università Cattolica del Sacro Cuore Rome Italy
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10
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Biagi E, Zama D, Rampelli S, Turroni S, Brigidi P, Consolandi C, Severgnini M, Picotti E, Gasperini P, Merli P, Decembrino N, Zecca M, Cesaro S, Faraci M, Prete A, Locatelli F, Pession A, Candela M, Masetti R. Early gut microbiota signature of aGvHD in children given allogeneic hematopoietic cell transplantation for hematological disorders. BMC Med Genomics 2019; 12:49. [PMID: 30845942 PMCID: PMC6404274 DOI: 10.1186/s12920-019-0494-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/26/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The onset of acute Graft-versus-Host Disease (aGvHD) has been correlated with the gut microbiota (GM) composition, but experimental observations are still few, mainly involving cohorts of adult patients. In the current scenario where fecal microbiota transplantation has been used as a pioneer therapeutic approach to treat steroid-refractory aGvHD, there is an urgent need to expand existing observational studies of the GM dynamics in Hematopoietic Stem Cell Transplantation (HSCT). Aim of the present study is to explore the GM trajectory in 36 pediatric HSCT recipients in relation to aGvHD onset. METHODS Thirty-six pediatric patients, from four transplantation centers, undergoing HSCT were enrolled in the study. Stools were collected at three time points: before HSCT, at time of engraftment and > 30 days following HSCT. Changes in the GM phylogenetic structure were studied by 16S rRNA gene Illumina sequencing and phylogenetic assignation. RESULTS Children developing gut aGvHD had a dysbiotic GM layout before HSCT occurred. This putative aGvHD-predisposing ecosystem state was characterized by (i) reduced diversity, (ii) lower Blautia content, (iii) increase in Fusobacterium abundance. At time of engraftment, the GM structure underwent a deep rearrangement in all patients but, regardless of the occurrence of aGvHD and its treatment, it reacquired a eubiotic configuration from day 30. CONCLUSIONS We found a specific GM signature before HSCT predictive of subsequent gut aGvHD occurrence. Our data may open the way to a GM-based stratification of the risk of developing aGvHD in children undergoing HSCT, potentially useful also to identify patients benefiting from prophylactic fecal transplantation.
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Affiliation(s)
- Elena Biagi
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126, Bologna, Italy.
| | - Daniele Zama
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", Department of Pediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Simone Rampelli
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126, Bologna, Italy
| | - Silvia Turroni
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126, Bologna, Italy
| | - Patrizia Brigidi
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126, Bologna, Italy
| | - Clarissa Consolandi
- Institute of Biomedical Technologies, Italian National Research Council, Via Fratelli Cervi 93, 20090, Segrate, Milan, Italy
| | - Marco Severgnini
- Institute of Biomedical Technologies, Italian National Research Council, Via Fratelli Cervi 93, 20090, Segrate, Milan, Italy
| | - Eleonora Picotti
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", Department of Pediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Pietro Gasperini
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", Department of Pediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Pietro Merli
- Department of Pediatric Hematology/Oncology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Nunzia Decembrino
- Division of Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Zecca
- Division of Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Cesaro
- Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Maura Faraci
- Hematopoietic stem cell Unit, Department of Hematology-Oncology, IRCCS-Istituto Gaslini, Genoa, Italy
| | - Arcangelo Prete
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", Department of Pediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology/Oncology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Andrea Pession
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", Department of Pediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Marco Candela
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126, Bologna, Italy
| | - Riccardo Masetti
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", Department of Pediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
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11
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Candoni A, Klimko N, Busca A, Di Blasi R, Shadrivova O, Cesaro S, Zannier ME, Verga L, Forghieri F, Calore E, Nadali G, Simonetti E, Muggeo P, Quinto AM, Castagnola C, Cellini M, Del Principe MI, Fracchiolla N, Melillo L, Piedimonte M, Zama D, Farina F, Giusti D, Mosna F, Capelli D, Delia M, Picardi M, Decembrino N, Perruccio K, Vallero S, Aversa F, Fanin R, Pagano L. Fungal infections of the central nervous system and paranasal sinuses in onco-haematologic patients. Epidemiological study reporting the diagnostic-therapeutic approach and outcome in 89 cases. Mycoses 2019; 62:252-260. [PMID: 30565742 DOI: 10.1111/myc.12884] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/08/2018] [Accepted: 12/09/2018] [Indexed: 02/02/2023]
Abstract
Invasive fungal infections (IFI) of the Central Nervous System (IFI-CNS) and Paranasal Sinuses (IFI-PS) are rare, life-threatening infections in haematologic patients, and their management remains a challenge despite the availability of new diagnostic techniques and novel antifungal agents. In addition, analyses of large cohorts of patients focusing on these rare IFI are still lacking. Between January 2010 and December 2016, 89 consecutive cases of Proven (53) or Probable (36) IFI-CNS (71/89) and IFI-PS (18/89) were collected in 34 haematological centres. The median age was 40 years (range 5-79); acute leukaemia was the most common underlying disease (69%) and 29% of cases received a previous allogeneic stem cell transplant. Aspergillus spp. were the most common pathogens (69%), followed by mucormycetes (22%), Cryptococcus spp. (4%) and Fusarium spp. (2%). The lung was the primary focus of fungal infection (48% of cases). The nervous system biopsy was performed in 10% of IFI-CNS, and a sinus biopsy was performed in 56% of IFI-PS (P = 0.03). The Galactomannan test on cerebrospinal fluid has been performed in 42% of IFI-CNS (30/71), and it was positive in 67%. Eighty-four pts received a first-line antifungal therapy with Amphotericine B in 58% of cases, Voriconazole in 31% and both in 11%. Moreover, 58% of patients received 2 or more lines of therapy and 38% were treated with a combination of 2 or more antifungal drugs. The median duration of antifungal therapy was 60 days (range 5-835). A surgical intervention was performed in 26% of cases but only 10% of IFI-CNS underwent neurosurgical intervention. The overall response rate to antifungal therapy (complete or partial response) was 57%, and 1-year overall survival was 32% without significant differences between IFI-CNS and IFI-PS. The overall mortality was 69% but the IFI attributable mortality was 33%. Mortality of IFI-CNS/PS remains high but, compared to previous historical data, it seems to be reduced probably due to the availability of newer antifungal drugs. The results arising from this large contemporary cohort of cases may allow a more effective diagnostic and therapeutic management of these very rare IFI complications in haematologic patients.
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Affiliation(s)
- A Candoni
- Clinica Ematologica, ASUI, Udine, Italy
| | - N Klimko
- Metchnikov North-Western State Medical University, St. Petersburg, Russia
| | - A Busca
- S.C. Ematologia, AO Città della Salute e della Scienza, Torino, Italy
| | - R Di Blasi
- Istituto di Ematologia, Polo Onco-Ematologico Fondazione Policlinico A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - O Shadrivova
- Metchnikov North-Western State Medical University, St. Petersburg, Russia
| | - S Cesaro
- Oncoematologia Pediatrica, AOUI, Verona, Italy
| | | | - L Verga
- Clinica Ematologica, Ospedale S Geraldo, Monza, Italy
| | - F Forghieri
- Clinica Ematologica, Dipartimento di Scienze Mediche-Chirurgiche, Università di Modena, Modena, Italy
| | - E Calore
- Clinica di Oncoematologia pediatrica, Dipartimento di Salute della Donna e del Bambino, Azienda Ospedaliero-Universitaria, Padova, Italy
| | - G Nadali
- U.O.C. Ematologia, AOUI, Policlinico GB Rossi, Verona, Italy
| | - E Simonetti
- Ematologia, Ospedale SM Misericordia, Perugia, Italy
| | - P Muggeo
- Oncoematologia Pediatrica, AOUC Policlinico, Bari, Italy
| | - A M Quinto
- UO di Ematologia, Dipartimento di Medicina, AO di Padova, Padova, Italy
| | - C Castagnola
- Dipartimento Oncoematologico Fondazione, ICRRS Policlinico San Matteo, Pavia, Italy
| | - M Cellini
- UO Pediatria, Dipartimento Materno-Infantile, AOU Policlinico, Modena, Italy
| | - M I Del Principe
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italy
| | - N Fracchiolla
- UO Oncoematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - L Melillo
- Divisione di Ematologia, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - M Piedimonte
- Dipartimento di Clinica e di Medicina Molecolare, AOU Sant'Andrea, Università Sapienza, Roma, Italy
| | - D Zama
- Oncoematologia Pediatrica, Ospedale Sant Orsola Malpighi, Bologna, Italy
| | - F Farina
- Clinica Ematologica, Ospedale S Geraldo, Monza, Italy
| | - D Giusti
- Clinica Ematologica, Dipartimento di Scienze Mediche-Chirurgiche, Università di Modena, Modena, Italy
| | - F Mosna
- Struttura Complessa Ematologia, Ospedale Ca' Foncello, Treviso, Italy
| | - D Capelli
- Clinica Ematologica, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M Delia
- Sezione di Ematologia, Università degli studi di Bari, Bari, Italy
| | - M Picardi
- Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Napoli, Italy
| | - N Decembrino
- Oncoematologia Pediatrica, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - K Perruccio
- Oncoematologia Pediatrica, Ospedale SM Misericordia, Perugia, Italy
| | - S Vallero
- Ematologia Pediatrica, Ospedale Infantile Regina Margherita S. Anna, Torino, Italy
| | - F Aversa
- Ematologia e Centro Trapianti Midollo Osseo, Università di Parma, Parma, Italy
| | - R Fanin
- Clinica Ematologica, ASUI, Udine, Italy
| | - L Pagano
- Istituto di Ematologia, Polo Onco-Ematologico Fondazione Policlinico A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
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12
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Del Principe MI, Dragonetti G, Verga L, Candoni A, Marchesi F, Cattaneo C, Delia M, Potenza L, Farina F, Ballanti S, Decembrino N, Castagnola C, Nadali G, Fanci R, Orciulo E, Veggia B, Offidani M, Melillo L, Manetta S, Tumbarello M, Venditti A, Busca A, Aversa F, Pagano L, Pepa RD, Ferrari A, Piedimonte M, Andrea OS, Fracchiolla NS, Sciumè M, Lessi F, Prezioso L, Spolzino A, Rambaldi B, Russo D, di Ematologia C, Maracci L, Sarlo C, Annibali O, Cefalo M, Zizzari A, Blasi RD, Zama D, Mancini V, Salutari P, Cesaro S, Garzia MG, Vacca A, Dargenio M, Invernizzi R, Perruccio K, Quinto AM, Chierichini A, Spadea A. ‘Real-life’ analysis of the role of antifungal prophylaxis in preventing invasive aspergillosis in AML patients undergoing consolidation therapy: Sorveglianza Epidemiologica Infezioni nelle Emopatie (SEIFEM) 2016 study. J Antimicrob Chemother 2019; 74:1062-1068. [DOI: 10.1093/jac/dky550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/23/2018] [Accepted: 11/30/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Maria Ilaria Del Principe
- Cattedra di Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma ‘Tor Vergata’, Roma, Italy
| | - Giulia Dragonetti
- Istituto di Ematologia, Fondazione Policlinico Universitario A. Gemelli-IRCCS-Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luisa Verga
- Clinica Ematologica, Ospedale San Gerardo, ASST Monza, Università Milano Bicocca, Milano, Italy
| | - Anna Candoni
- Clinica di Ematologia e Unità di terapie Cellulari ‘Carlo Melzi’-Azienda Sanitaria-Universitaria, Integrata, Udine, Italy
| | - Francesco Marchesi
- Haematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - Chiara Cattaneo
- Divisione di Ematologia, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Mario Delia
- Sezione di Ematologia, Dipartimento dell'Emergenza e dei Trapianti d'Organo-Università di Bari, Bari, Italy
| | - Leonardo Potenza
- UOC Ematologia, Dipartimento di Scienze Mediche e Chirurgiche Materno infantili e dell’Adulto, Università di Modena e Reggio Emilia, Modena, Italy
| | | | | | - Nunzia Decembrino
- UOC Oncoematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlo Castagnola
- Dipartimento Onco-Ematologico Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gianpaolo Nadali
- Unità Operativa Complessa di Ematologia, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Rosa Fanci
- Unità Funzionale di Ematologia, Azienda Ospedaliero-Universitaria Careggi e Università di Firenze, Firenze, Italy
| | - Enrico Orciulo
- Dipartimento di Oncologia, Trapianti e Tecnologie Avanzate, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Massimo Offidani
- Clinica di Ematologia, Azienda Ospedaliero-Universitaria, Ospedali Riunti di Ancona, Ancona, Italy
| | - Lorella Melillo
- Divisione di Ematologia, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Sara Manetta
- Stem Cell Transplant Centre, AOU Citta’ della Salute e della Scienza, Torino, Italy
| | - Mario Tumbarello
- Istituto di Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli-IRCCS-Università Cattolica del Sacro Cuore, Roma, Italy
| | - Adriano Venditti
- Cattedra di Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma ‘Tor Vergata’, Roma, Italy
| | - Alessandro Busca
- Stem Cell Transplant Centre, AOU Citta’ della Salute e della Scienza, Torino, Italy
| | - Franco Aversa
- Dipartimento di Medicina Interna, Università di Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Livio Pagano
- Istituto di Ematologia, Fondazione Policlinico Universitario A. Gemelli-IRCCS-Università Cattolica del Sacro Cuore, Roma, Italy
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Muggeo P, Calore E, Decembrino N, Frenos S, De Leonardis F, Colombini A, Petruzziello F, Perruccio K, Berger M, Burnelli R, Zanazzo GA, Santoro N, Cesaro S. Invasive mucormycosis in children with cancer: A retrospective study from the Infection Working Group of Italian Pediatric Hematology Oncology Association. Mycoses 2018; 62:165-170. [PMID: 30338581 DOI: 10.1111/myc.12862] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/08/2018] [Accepted: 10/11/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Invasive mucormycosis is a rare but frequently fatal fungal disease. The acute and rapidly progressive evolution causes unfavourable outcome in 22%-59% of patients and its treatment represents a clinical challenge, especially in immunocompromised patients. Current data in paediatric oncological patients are limited. OBJECTIVES The infection Working Group of the Italian Association of Pediatric Hematology and Oncology (AIEOP) analysed the episodes of invasive mucormycosis occurred between 2009 and 2016. PATIENTS Fifteen cases of proven mucormycosis (male/female 8/7; median age 14.1 years, range 7.7-18.6) were reported after chemotherapy for acute leukaemia and lymphoma (12) and allogeneic stem cell transplantation (3). The aetiology was Rhizopus oryzae 4, Lichtheimia corymbifera 3 and Mucor spp. 8. RESULTS Paranasal sinus was the primary site of infection in 14/15 patients combined with orbital involvement (9), central nervous system (8), lung (4), thyroid gland and kidney (1). All patients received liposomal Amphotericin B (L-AmB) (3-10 mg/kg), with surgical debridement in 14/15 cases. Eleven patients received maintenance treatment with posaconazole (9) or isavuconazole (2). Eight out of fifteen patients (53.3%) died, after 3-6 months. CONCLUSIONS Mucormycosis involved mainly the sinu-orbital site and affected children >10 years. Despite aggressive treatment with high-dose L-AmB and timely surgical debridement, the mortality rate remains still high.
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Affiliation(s)
- Paola Muggeo
- Department of Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari, Bari, Italy
| | - Elisabetta Calore
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Nunzia Decembrino
- Pediatric Hematology Oncology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefano Frenos
- Oncoematologia Pediatrica, Ospedale Meyer, Firenze, Italy
| | - Francesco De Leonardis
- Department of Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari, Bari, Italy
| | | | | | - Katia Perruccio
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Massimo Berger
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, AOU Città della Salute e della Scienza, Regina Margherita Children Hospital, Turin, Italy
| | - Roberta Burnelli
- Pediatric Onco-Hematology Unit, Sant'Anna University Hospital, Ferrara, Italy
| | - Giulio A Zanazzo
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste, Trieste, Italy
| | - Nicola Santoro
- Department of Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari, Bari, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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14
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Gobbo M, Verzegnassi F, Ronfani L, Zanon D, Melchionda F, Bagattoni S, Majorana A, Bardellini E, Mura R, Piras A, Petris MG, Mariuzzi ML, Barone A, Merigo E, Decembrino N, Vitale MC, Berger M, Defabianis P, Biasotto M, Ottaviani G, Zanazzo GA. Multicenter randomized, double-blind controlled trial to evaluate the efficacy of laser therapy for the treatment of severe oral mucositis induced by chemotherapy in children: laMPO RCT. Pediatr Blood Cancer 2018; 65:e27098. [PMID: 29727048 DOI: 10.1002/pbc.27098] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 03/16/2018] [Accepted: 03/18/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To demonstrate the efficacy of laser photobiomodulation (PBM) compared to that of placebo on severe oral mucositis (OM) in pediatric oncology patients. The primary objective was the reduction of OM grade (World Health Organization [WHO] scale) 7 days after starting PBM. Secondary objectives were reduction of pain, analgesic consumption, and incidence of side effects. METHODS One hundred and one children with WHO grade > 2 chemotherapy-induced OM were enrolled in eight Italian hospitals. Patients were randomized to either PBM or sham treatment for four consecutive days (days +1 to +4). On days +4, +7, and +11, OM grade, pain (following a 0-10 numeric pain rating scale, NRS) and need for analgesics were evaluated by an operator blinded to treatment. RESULTS Fifty-one patients were allocated to the PBM group, and 50 were allocated to the sham group. In total, 93.7% of PBM patients and 72% of sham patients had OM grade < 3 WHO on day +7 (P = 0.01). A significant reduction of pain was registered on day +7 in the PBM versus sham group (NRS 1 [0-3] vs. 2.5 [1-5], P < 0.006). Reduced use of analgesics was reported in the PBM group, although it was not statistically significant. No significant adverse events attributable to treatment were recorded. CONCLUSIONS PBM is a safe, feasible, and effective treatment for children affected by chemotherapy-induced OM, as it accelerates mucosal recovery and reduces pain.
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Affiliation(s)
- Margherita Gobbo
- Division of Oral Medicine and Pathology, Department of Dental Science, University of Trieste, Trieste, Italy
| | - Federico Verzegnassi
- Pediatric Hemato-Oncology Unit, IRCCS materno infantile Burlo Garofolo, Trieste, Italy
| | - Luca Ronfani
- Epidemiology and Biostatistics Unit, IRCCS materno infantile Burlo Garofolo, Trieste, Italy
| | - Davide Zanon
- Pharmacy and Clinical Pharmacology, IRCCS materno infantile Burlo Garofolo, Trieste, Italy
| | - Fraia Melchionda
- Pediatric Oncology and Haematology Unit "Lalla Seràgnoli," Department of Pediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Simone Bagattoni
- Unit of Dental Care for Special Needs Patients and Paediatric Dentistry, Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Alessandra Majorana
- Department of Medical and Surgical Specialities, Radiological Science and Public Health, Dental School University of Brescia, Brescia, Italy
| | - Elena Bardellini
- Department of Biomedical, Biotechnological, and Translational Sciences, Dental School, University of Brescia, Brescia, Italy
| | - Rosamaria Mura
- Paediatric Haematology and Oncology Unit, Ospedale Pediatrico Microcitemico, Cagliari, Italy
| | - Alessandra Piras
- Division of Dental Medicine, Department of Medical Science, LUdeS HEI Foundation Malta
| | | | | | - Angelica Barone
- Pediatric and Onco-Hematology Unit, University of Parma, Parma, Italy
| | - Elisabetta Merigo
- Dental School, Department of Biomedical, Biotechnological and Translational Sciences, University of Parma, Parma, Italy
| | - Nunzia Decembrino
- Pediatric Hematology Oncology Unit, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Marina Consuelo Vitale
- Sezione di Ortognatodonzia e Odontoiatria Pediatrica, Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia, Pavia, Italy
| | - Massimo Berger
- Oncoematologia Pediatrica, Ospedale Infantile Regina Margherita, Torino, Italy
| | - Patrizia Defabianis
- Section of Pediatric Dentistry, Dental School, University of Torino, Torino, Italy
| | - Matteo Biasotto
- Division of Oral Medicine and Pathology, Department of Dental Science, University of Trieste, Trieste, Italy
| | - Giulia Ottaviani
- Division of Oral Medicine and Pathology, Department of Dental Science, University of Trieste, Trieste, Italy
| | - Giulio Andrea Zanazzo
- Pediatric Hemato-Oncology Unit, IRCCS materno infantile Burlo Garofolo, Trieste, Italy
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15
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Vicenzi EB, Calore E, Decembrino N, Berger M, Perruccio K, Carraro F, Rossin S, Putti MC, Molinaro M, Tridello G, Cesaro S. Posaconazole oral dose and plasma levels in pediatric hematology-oncology patients. Eur J Haematol 2018; 100:315-322. [PMID: 29240266 DOI: 10.1111/ejh.13017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Posaconazole is a triazole with limited pharmacokinetic information in children. This study assessed the correlation between posaconazole oral solution daily dosage/kg/body weight and trough plasma level. METHODS A total of 97 hematology-oncology pediatric patients with ≥1 posaconazole plasma concentration level (PPC) assessment in the first 6 weeks after the start of posaconazole treatment were included. RESULTS Posaconazole was used as prophylaxis in 84 of 97 (87%) patients and as therapy in 13 of 97 (13%). The median daily dose/kg/bw ranged from 10 to 12 mg in the prophylaxis group and 12.5 to 16.5 mg in the therapy group. The median value of PPC for the prophylaxis group was 0.9 and 0.8 μg/mL at the first and second/third determinations, respectively. Posaconazole prophylaxis failed in 4 of 84 patients (5%). The median value of PPC for the therapy group was 1.5 and 1.4 μg/mL at the first/second and the third determination, respectively. Posaconazole-related side effects were reported in 6 patients and all regressed with the suspension of the drug. In the prophylaxis group, the use of proton-pump inhibitors was significantly associated with a lower PPC, P = 0.04. CONCLUSIONS Posaconazole may be a valuable antifungal agent in children despite the incomplete knowledge of its pharmacokinetic characteristics.
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Affiliation(s)
- Edoardo Bruno Vicenzi
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Elisabetta Calore
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Nunzia Decembrino
- Pediatric Hematology Oncology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Massimo Berger
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, AOU Città della Salute e della Scienza, Regina Margherita Childrens Hospital, Turin, Italy
| | - Katia Perruccio
- Pediatric Hematology-Oncology, Azienda Ospedaliera Universitaria, Perugia, Italy
| | - Francesca Carraro
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, AOU Città della Salute e della Scienza, Regina Margherita Childrens Hospital, Turin, Italy
| | - Sara Rossin
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Maria Caterina Putti
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Mariadelfina Molinaro
- Clinical and Experimental Pharmacokinetics Unit, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gloria Tridello
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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16
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Pagano L, Dragonetti G, Cattaneo C, Marchesi F, Veggia B, Busca A, Candoni A, Prezioso L, Criscuolo M, Cesaro S, Delia M, Fanci R, Stanzani M, Ferrari A, Martino B, Melillo L, Nadali G, Simonetti E, Ballanti S, Picardi M, Castagnola C, Decembrino N, Gazzola M, Fracchiolla NS, Mancini V, Nosari A, Principe MID, Aversa F, Tumbarello M. Changes in the incidence of candidemia and related mortality in patients with hematologic malignancies in the last ten years. A SEIFEM 2015-B report. Haematologica 2017; 102:e407-e410. [PMID: 28729301 DOI: 10.3324/haematol.2017.172536] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Livio Pagano
- Department of Onco-Hematology, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica del Sacro Cuore, Rome
| | - Giulia Dragonetti
- Department of Onco-Hematology, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica del Sacro Cuore, Rome
| | | | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit Regina Elena National Cancer Institute, Rome
| | - Barbara Veggia
- Hematology, Azienda Ospedaliera S.Giovanni Addolorata, Rome, Italy
| | - Alessandro Busca
- SSD Trapianto Cellule Staminali, A.O.U. Citta' della Salute, Torino, Italy
| | - Anna Candoni
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari, Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | | | - Marianna Criscuolo
- Department of Onco-Hematology, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica del Sacro Cuore, Rome
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Italy
| | - Mario Delia
- Dipartimento dell'Emergenza e dei Trapianti Di Organo - U.O Ematologia con Trapianto - Azienda Ospedaliero-Universitaria - Policlinico di Bari, Italy
| | - Rosa Fanci
- Hematology, University of Firenze, Italy
| | | | - Antonella Ferrari
- UOC Ematologia, Az. Ospedaliera Sant'Andrea, Università "Sapienza" Rome, Italy
| | - Bruno Martino
- Hematology, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy
| | - Lorella Melillo
- Hematology, S. Giovanni Rotondo Hospital University of Verona, Naples, Italy
| | | | | | | | - Marco Picardi
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Carlo Castagnola
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | | | - Valentina Mancini
- Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Annamaria Nosari
- Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Maria Ilaria Del Principe
- Hematology, Dipartimento di Biomedicina e Prevenzione Università degli Studi di Roma Tor Vergata, Rome, Italy
| | | | - Mario Tumbarello
- Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli- Università Cattolica del Sacro Cuore, Rome, Italy
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17
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Corbella M, Brandolini M, Cambieri P, Decembrino N, Pagani M, Bottazzi A, Muzzi A, Zecca M, Mariani B, Marone P. A catheter-related bloodstream infection caused by Chryseobacterium indologenes successfully treated with antibiotic-lock rescue therapy. New Microbiol 2017; 40:223-225. [PMID: 28675244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 06/07/2023]
Abstract
We report the case of a catheter-related bloodstream infection caused by Chryseobacterium indologenes, an uncommon and multi-resistant pathogen, in a pediatric patient with a long-term vascular access device placed for chemotherapy treatment. The infection was successfully treated with ciprofloxacin antibiotic-lock therapy. This is the first report on successful salvage of a long-term device colonized by multi-resistant Chryseobacterium indologenes.
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Affiliation(s)
- Marta Corbella
- Servizio di Biometria ed Epidemiologia Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- S.C. Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Micaela Brandolini
- S.C. Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Patrizia Cambieri
- S.C. Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nunzia Decembrino
- S.C. Oncoematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Michele Pagani
- S.C. Anestesia e Rianimazione 2, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Bottazzi
- S.C. Anestesia e Rianimazione 2, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alba Muzzi
- Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Zecca
- S.C. Oncoematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Bianca Mariani
- S.C. Oncoematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Piero Marone
- S.C. Oncoematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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18
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Cesaro S, Tridello G, Castagnola E, Calore E, Carraro F, Mariotti I, Colombini A, Perruccio K, Decembrino N, Russo G, Maximova N, Baretta V, Caselli D. Retrospective study on the incidence and outcome of proven and probable invasive fungal infections in high-risk pediatric onco-hematological patients. Eur J Haematol 2017; 99:240-248. [DOI: 10.1111/ejh.12910] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2017] [Indexed: 10/25/2022]
Affiliation(s)
- Simone Cesaro
- Pediatric Hematology Oncology; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - Gloria Tridello
- Pediatric Hematology Oncology; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - Elio Castagnola
- Pediatric Infectious Disease; Istituto Giannina Gaslini; Genoa Italy
| | - Elisabetta Calore
- Department of Women's and Children's Health; Clinic of Pediatric Hemato-Oncology; University Hospital of Padova; Padova Italy
| | - Francesca Carraro
- Pediatric Onco-Hematology; Stem Cell Transplantation and Cellular Therapy Division; AOU Città della Salute e della Scienza; Regina Margherita Childrens Hospital; Turin Italy
| | - Ilaria Mariotti
- Pediatric Hematology Oncology; Azienda Ospedaliera Universitaria; Modena Italy
| | | | - Katia Perruccio
- Pediatric Hematology Oncology; Azienda Ospedaliera Universitaria; Perugia Italy
| | - Nunzia Decembrino
- Pediatric Hematology Oncology; IRCCS Policlinico San Matteo; University of Pavia; Pavia Italy
| | - Giovanna Russo
- Pediatric Hematology Oncology; A.O.U. Policlinico-Vittorio Emanuele Catania; Catania Italy
| | - Natalia Maximova
- Bone Marrow Transplant Unit; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Valentina Baretta
- Pediatric Hematology Oncology; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - Désirée Caselli
- Pediatric Hematology Oncology; Meyer Hospital; University of Florence; Firenze Italy
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19
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Vitale MC, Modaffari C, Decembrino N, Zhou FX, Zecca M, Defabianis P. Preliminary study in a new protocol for the treatment of oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT) and chemotherapy (CT). Lasers Med Sci 2017; 32:1423-1428. [DOI: 10.1007/s10103-017-2266-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/15/2017] [Indexed: 01/01/2023]
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20
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Decembrino N, Zecca M, Tortorano AM, Mangione F, Lallitto F, Introzzi F, Bergami E, Marone P, Tamarozzi F, Cavanna C. Acute isolated appendicitis due to Aspergillus carneus in a neutropenic child with acute myeloid leukemia. New Microbiol 2016; 39:65-69. [PMID: 26922988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/06/2015] [Indexed: 06/05/2023]
Abstract
We describe a case of isolated acute appendicitis due to Aspergillus carneus in a neutropenic child with acute myeloid leukemia (AML) treated according to the AIEOP AML 2002/01 protocol. Despite prophylaxis with acyclovir, ciprofloxacin and fluconazole administered during the neutropenic phase, 16 days after the end of chemotherapy the child developed fever without identified infective foci, which prompted a therapy shift to meropenem and liposomial amphotericin B. After five days of persisting fever he developed ingravescent abdominal lower right quadrant pain. Abdominal ultrasound was consistent with acute appendicitis and he underwent appendectomy with prompt defervescence. PAS+ fungal elements were found at histopathology examination of the resected vermiform appendix, and galactomannan was low positive. A. carneus, a rare species of Aspergillus formerly placed in section Flavipedes and recently considered a member of section Terrei, was identified in the specimen. Treatment with voriconazole was promptly started with success. No other site of Aspergillus localization was detected. Appendicitis is rarely caused by fungal organisms and isolated intestinal aspergillosis without pulmonary infection is unusual. To our knowledge, this is the first report of infection due to A. carneus in a child and in a primary gastrointestinal infection.
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Affiliation(s)
- Nunzia Decembrino
- Pediatric Hematology/Oncology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Marco Zecca
- Pediatric Hematology/Oncology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | | | - Francesca Mangione
- Microbiology and Virology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Fabiola Lallitto
- Microbiology and Virology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Francesca Introzzi
- Pediatric Hematology/Oncology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Elena Bergami
- Pediatric Hematology/Oncology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Piero Marone
- Microbiology and Virology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Francesca Tamarozzi
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Caterina Cavanna
- Microbiology and Virology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
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21
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Abstract
Outbreaks in neonatal intensive care units (NICUs) have disastrous consequences for neonates and raise enormous concerns in staff, altering usual practice patterns of the NICU. Our objective was to perform a systematic analysis for gaining insights into the control and prevention of NICUs outbreaks. Epidemiology, risk factors and outcomes are reviewed.
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Affiliation(s)
- Lidia Decembrino
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Antonella Maini
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nunzia Decembrino
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ivana Maggi
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Serafina Lacerenza
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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22
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Corona G, Giogianni G, Aversa S, Decembrino N, Artemisia A, Cordaro V, Barberi I. Variations of Procalcitonin Serum Levels in Neonatal Period. Int J Infect Dis 2008. [DOI: 10.1016/j.ijid.2008.05.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Calcagno G, Vitale A, La Torre F, Decembrino N, Fede C, Falcini F. Behçet Disease (BD) in two siblings affected with Familial Mediterranean Fever (FMF). Pediatr Rheumatol Online J 2008. [PMCID: PMC3334071 DOI: 10.1186/1546-0096-6-s1-p263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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